Changes in abortion payment regulations draw mixed reactions

A change in the way the state processes Medicaid payment for “medically necessary” abortions has drawn criticism from some and support from others on the Kenai Peninsula.

The new regulations, which take effect Feb. 2, will require abortion providers to further define what constitutes a medically necessary abortion — a requirement to receive Medicaid or Medicare reimbursement for the procedure.

“It doesn’t differ much from how we were doing it before, it just asks for more detail,” said state Health and Social Services Commissioner Bill Streur. “I was concerned that we were paying for a whole lot of abortions that we didn’t have the money for. We wanted to get details for why these were federally necessary.”

To get that information, the state modified its “Certificate to Request Funds for Abortion” which previously had two boxes for an abortion provider to pick from: one that certified the abortion to be the result of rape or incest; the other that the abortion procedure was medically necessary.

Now, the certificate has 23 categories for a medically necessary abortion, including severe pre-eclampsia, congestive heart failure, epilepsy or a psychiatric disorder that places a woman “in imminent danger of medical impairment of a major bodily function.”

Critics of the new certificate call the changes an attempt to define “medically necessary” in a way that is unconstitutional.

“What’s concerning for us is that we know no two people are alike,” said Treasure Mackley, political and organizing director of Planned Parenthood of the Greater Northwest. “This list of (23) conditions … it’s certainly not all-encompassing and it doesn’t reflect the uniqueness of every human being and every pregnancy.”

During the public input portion of implementing the proposed changes to the certificate, the state received about 400 comments on the issue.

Streur characterized the majority of the comments as “boilerplate,” however he would not release them without a Freedom of Information Act Request and his office has yet to respond to the request.

“There were several thoughtful emails opposed to it,” he said. “But primarily speaking to the argument that we were restricting abortions… then there were probably 100 to 150 supportive.”

Colleen Ward, executive director of the ABC Pregnancy Care Center in Kenai, said she supported a restriction on the way public funds could be spent on pregnancy terminations.

The faith-based care center has been in operation for 30 years on the Kenai Peninsula and Ward said there was a fundamental divide between the way her organization viewed the discussion on abortion regulations and how Planned Parenthood represented its dissent.

“I heard ‘unconstitutional,’ and ‘discriminatory’ and ‘medical procedure,’” she said of the arguments against the changes. “It’s the subtleties, you hear things like unconstitutional and you hear things about discriminatory and for those of us who understand that life is in the womb, these words mean completely different things.”

Critics of the changes say the new regulations put a disproportionate burden on low-income women who need abortion services, as they only affect women seeking Medicaid or Medicare reimbursement for the procedure.

“This is tantamount to a nearly complete ban on abortion to low income women in Alaska,” Mackley said.

Ward said low-income women were often subject to a lot of variables that made them want to terminate a pregnancy that could be changed.

“People tell us, it’s often based on variable like ‘they don’t feel like they can afford a baby, their career doesn’t allow it, the father of the baby isn’t interested in them having a baby,’ … what we do here is share a truth about their situation that isn’t represented in our culture,” Ward said.

The center offers parenting classes and support for potential mothers who don’t feel capable of dealing with a pregnancy on their own, she said.

Ward, along with other proponents of the changes, said she did not want public money to be spent reimbursing any kind of abortion.

“We are entitled in this country still to our religious freedom and there is nothing within my faith system that allows for me to contribute to abortion,” Ward said. “So, public money comes form private individuals and those private individuals have rights and those rights, for many of us pertain to our value system — our religious belief, our understanding that life, the sanctity of life — that is one of our strongest value systems.”

Ward said the pregnancy care center had about 316 client visits in 2013 and emphasized providing support for expectant mothers — even if that mother eventually chose to terminate her pregnancy.

Still, she said there are indications that the community supports a pro-life stance that would not be supportive of the state spending public money reimbursing the procedure.

While the regulation has yet to go into effect, Mackley said it was likely that someone would mount a legal challenge against the expanded certificate.